Where to start? The Irish Emergency Department Antimicrobial Discharge (EDAD) study:a multicentre, prospective cohort analysis

Objectives: To determine the percentage of patients across Ireland who are discharged from the Emergency Department (ED) with an antimicrobial prescription, the indication, classification of infections, and guideline compliance. To identify potential areas for antimicrobial stewardship (AMS) interventions in the ED. Patients and methods: A multicentre, prospective cohort analysis study in EDs across eight hospitals in Ireland. At each site, patients aged 1 month and older who presented to the ED and were discharged directly from the ED were included. A random selection of records of patients discharged from the ED were reviewed until a minimum of 30 records with an infection diagnosis resulting in an antibiotic prescription were obtained per hospital. The number of patient discharges with no antibiotic prescriptions were included to calculate the denominator. The indication, infection classification and guideline compliance data were collected on the 30 prescriptions in the participating hospitals. Results: A total of 2619 patient records were reviewed. Of these, 249 (9.5%) patients were discharged with antimicrobial prescriptions from the ED. Most (158; 63%) were classified as probable bacterial infection, 21 (8%) as probable viral, and 18 (7%) had no documented evidence of infection. Three indications accounted for 73% of antimicrobial prescriptions: skin/soft tissue infection; ear, nose and throat infection; and urinary tract infection. Overall guideline compliance was 64%. Conclusions: Several areas for AMS interventions to optimize antimicrobial prescribing in the ED were identified, including targeted local and national guideline reviews, delayed prescribing, improved point-of-care testing and prescriber and patient education

The dress and individual differences in the perception of surface properties

This study investigates systematic individual differences in the way observers perceive different kinds of surface properties and their relationship to the dress, which shows striking individual differences in colour perception. We tested whether these individual differences have a common source, namely differences in perceptual strategies according to which observers attribute features in two-dimensional images to surfaces or to their illumination. First, we reanalysed data from two previous experiments on the dress and colour constancy. The comparison of the two experiments revealed that the colour perception of the dress is strongly related to individual differences in colour constancy. Second, two online surveys measured individual differences in the perception of colour-ambiguous images including the dress, in colour constancy, in gloss perception, in the subjective grey-point, in colour naming, and in the perception of an image with ambiguous shading. The results of the surveys replicated and extended previous findings according to which individual differences in the colour perception of the dress are due to implicit assumptions about the illumination. However, results also showed that the individual differences for other phenomena were independent of the dress and of each other. Overall, these results suggest that the striking individual differences in dress colour perception are due to individual differences in the interpretation of illumination cues to achieve colour constancy. At the same time, they undermine the idea of an overall perceptual strategy that encompasses other phenomena more generally related to the interpretation of illumination and surface properties